Where have all the nurses gone?

[Lu Dawn]

Where have all the nurses gone?

Nursing has changed drastically over the past 30 years. A time came when nurses were actively encouraged to return to college and earn their BSN. Not too much later they were encouraged to return once again and earn their MSN. I ask you, to what end? Well, the fact of the matter is, institutions are not willing to pay nurses for their educational experiences and most of the nurses that did and are returning to college to earn higher degrees in the nursing field are no longer desiring to do bedside nursing. These nurses are applying for and being hired to fill non-bedside nursing positions, such as managers, clinical instructors, patient education positions, orientation class instructors, nursing research fields and the list goes on and on.

Why do these nurses want to leave bedside nursing? For one thing, bedside nursing is not what it used to be. There was a time when the public appreciated the people taking care of them in a hospital or emergency situation. The public has become better educated as to health care. They read articles, they see special programs via television, and now they have access to just about any and all medical and healthcare field information databases via the internet and the world of the world wide web! This can be and in most instances is a good thing. But when the person reclining in the hospital bed, feels that he or she knows more than the nurse with all of his or her vast knowledge base and world of experience, there develops clashes of what is felt to be best for that person laying there in the bad. The patient thinks he or she knows what is best for him or her and refuses to get out of bed, accusing the nurse of being rude or wanting to inflict undue pain upon them. They are hurting and they know as long as they lie there and do not move, they will not hurt as much as they would if they moved and got up out of that bed and walked around. Gone are the days that a nurse can simply walk into a room, sit down and talk with a patient, explaining why it is important for them to get up and move about, and then expect the patient to comply. Patients now come to a facility thinking that they will be waited on hand and foot. They do not need to turn over and get that glass of water because the nurse will get it for them, hand it to them with a straw in it and hold it for them while they sip the straw. This scenario is true. It happens more often than we would like to think. The "What ever the patient wants" attitude has developed over the past few years in an attempt to attract more and more patients to different facilities. This can be a good thing but in most instances it has developed a new group of people who can be and often are, rude, harsh, short and curt if their wants, needs and desires are not met instantly.

Point of fact is that if you look at the various age groups of the hospital patient population and ask just about any nurse, he or she will tell you that the older person generally makes the better more compliant patient. Why is this? Well, our society has developed a generation or two of people who want and demand instant gratification. These people are not willing to be patient and wait even a few minutes for their wants or needs to be taken care of. Many nurses function on the premise that I had better do everything just the way the patient wants me to or he or she will write me up and report me to administration. No one in their right mind wants anything like that to happen. So what does happen? The reality is that most of us let that person remain there in bed, not moving, until he or she decides it is time to turn over, or cough, or deep breath, or get up out of bed and take a few steps by the bedside. Yes, we still attempt to verbalize and communicate to our patient population what we know is in the best interest of the patients health and what will get him or her well and home in a timely manner. We give the patient what he or she needs to hear, ask them what they would like to know more about, and attempt to find the right sources of information to fill these. Take the slipper issue...these are warm little disposable slippers. Some patients want and get not one but two or even three pairs of these charged to them at each hospital stay. They complain that their feet are cold and ask for the slippers. One trip to the toilet they become wet or soiled and they ask for another pair while they throw the first pair in the trash. Would they so quickly throw away a pair of their own socks?

There is a generation of people that are still gracious and congenial. These are most of our senior citizens. They are grateful and appreciative for the care and teaching they receive. They grew up in a different era, one where they earned what they wanted, nothing handed to them freely and without question. These people are a blessing to work with. They ask questions instead of demanding chores be done for them. They turn themselves in bed and they get up early in their hospital stay and ambulate because they know this is the one thing they can do for themselves that will help them get better and return home quicker. This is NOT a generation of instant gratification. This is a generation that knows the value of please and thank you, and has not lost touch with human feelings of consideration and respect.

Other issues to be addresses:

The so-called "capping off" of pay

JACHO

Increase in technology and ever increasingly technical instruments and machines

Decrease in the so-called "whatever makes life easier for the nurse" attitude by administrations

The thought that "nurses and nursing staff are a dime a dozen". This had been verbalized out of the mouth of more than just a few hospital administrators! Does this make a person feel valued? Does this enhance a person's self-esteem and love of their work?

Changes and ever increasing demands of charting and documentation

What has happened to state nursing associations? Why are they not obviously actively recruiting and maintaining new members? Why is it so expensive to join one? What are they lobbying for in Congress that is so expensive? Should nurses be lobbying? What should nursing associations be doing? What should the yearly dues be? What part can each nurse do to improve the effectiveness of their individual nursing association? Why do not more nurses want to join a nursing association?

Increasing employer requirements of yearly nursing education classes that most nurses are expected to complete even if it takes them away from time with their families. Increasing CEU requirements of most state nursing licensures.

Why can Canadian nurses come and work in the States under different regulations than nurses already living here? Why is it so difficult to become licensed in more than one or two different states? Why is the nursing licensure process so different from state to state? What is being done to change this?

[Rena RN 2003, RN]

i'm sorry. i couldn't vote in your poll as it offers only a choice of one right answer. i believe that many of those options are reasons for past, present, and future nurses to leave bedside nursing.

i also couldn't read through your entire post. :chuckle lack of paragraphs make my eyes bleed.

[sjoe]

This would be a more useful poll if more than one choice could be made. As it stands, it just depends on what one happens to be thinking about at the moment. There are MANY, dovetailing, reasons.

[Lu Dawn]

You got the Points then and that is a good thing. Nursing 2003 can make your nose bleed and all of the above is the most likely answer.

Thank you,

Lu Dawn

2 Year ADN Program

Graduated 1987

[jlsand]

What a great letter Lu Dawn. I couldn't have said it better myself. I have believed that for years. It's one of the reasons why I like geriatrics better than taking care of the me, me, me generation on a med/surg unit!!!

my home page

[SmilingBluEyes]

UMM all the above????

[Lu Dawn]

hank you jlsand. I wrote it over a year ago while working in Dover, Delaware. I have worked in New Hampshire, Delaware, North Carolina and Saudi Arabia. I find the same things hapening all over.

[debyan]

Very true, there is a big difference in generational attitude.

There was not just one answer to your poll but when you added them together they equal one burned out nurse.

deb

[deespoohbear]

Like the other posters, I wish I could vote for more than one choice. I think most, if not all the choices are valid.

I have been a nurse for only 8 years, but I can tell you I am already burned out from bedside nursing. I am seriously considering other options besides bedside nursing. It is just too hard physically, emotionally, and mentally. Between JCAHO, state regs, facility policy I feel like I am have been regulated to death. Yes, I know that regulations are necessary but some of the rules that these think tanks come up with are ludicrous. And now we get to add the ever lovely HIPAA regs which are so confusing it makes one nervous to say anything to anybody about anyone for fear that Big Brother is going to lower the boom on you. I am tired of the weekends, the holidays, getting floated to other units for which I am not qualified, the verbal abuse by patients and families and so on. A person can only take so much in one lifetime before they get totally disillusioned.

Hopefully someday common sense will prevail (but I doubt it) and some of the nonsense will be halted. Of course it will take an act of God for that to happen. Until that day happens, nurses will continue to leave the bedside in droves never to return.

[RNforLongTime]

I voted for "burned out" but would have rather chosen "all of the above" had it been an option.

[Lu Dawn]

At the hospital I am currently working at, they have started to put the finishing touches on the meaning of 'stressed' and 'burned' out. They have loss thousands suddenly in a period of less than a couple of months.

They tried to make us feel it was our fault-the nurses-but we now know differently. They try to say it was losses due to self pays, Tricare and Medicaid and others, but we know when they negotiated with BCBS last month it hurt them greatly...more then they thought it would.

The hospital lost and the nurses and other staff are paying for it. We are verging on unsafe nursing practices. I work L&D in a 15 bed LDR Unit. What with being so close to a big military base and all the active duties sent off all over the world, our client numbers are down drastically. This adds insult to injury.

We are being called out more than once per week. They Last year they promised all the newly hired RN's there would be no shift cancellations...but we all know that this is next. Do they fail to realize, or tdo they simply do not care, they many of us are the sole providers of our households?

In the face of these cutbacks and call outs, our CEO got a $67,000 bonus and a pay hike to $375,000.00 per year with his contract extended through 2006. How 'bout them apples???

How many of you are experiencing similiar conditions at your facilities?

[altomga, ADN, BSN, MSN, DNP, RN, APRN]

I like most of the other ones who posted am unable to answer the poll. Many of (if not ALL) the choices are reasons for where nurses Have Gone! I have to agree with the others. Nurses suffer while the "higher ups" continue to get big fat raises/bonuses. While the nurses get a what.....maybe 3% raise on average. And then yes you get capped off after a certain point unless you climb the "clinical ladder". But even then you will get capped off at the new promotion level too. There is no easy answer to how to fix this problem. But continuing to crap on us is definately not IT!!!!